Case Law[2023] ZAGPPHC 420South Africa
Lotter v Road Accident Fund Appeal Tribunal and Others [2023] ZAGPPHC 420; 4035/2019 (26 May 2023)
Judgment
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# South Africa: North Gauteng High Court, Pretoria
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## Lotter v Road Accident Fund Appeal Tribunal and Others [2023] ZAGPPHC 420; 4035/2019 (26 May 2023)
Lotter v Road Accident Fund Appeal Tribunal and Others [2023] ZAGPPHC 420; 4035/2019 (26 May 2023)
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sino date 26 May 2023
IN
THE HIGH COURT OF SOUTH AFRICA,
GAUTENG
DIVISION, PRETORIA
CASE
NO:4035/2019
(1)
REPORTABLE: YES /
NO
(2)
OF INTEREST TO OTHER JUDGES: YES
/NO
(3)
REVISED: NO
DATE:26
MAY 2023
SIGNATURE
In
the matter between:
ILSE
LOTTER
APPLICANT
And
ROAD
ACCIDENT FUND APPEAL TRIBUNAL
FIRST RESPONDENT
THE
ROAD ACCIDENT FUND
SECOND RESPONDENT
THE
HEALTH PROFESSIONS COUNCIL OF
SOUTH
AFRICA
THIRD
RESPONDENT
PROF
A ADEN
FOURTH RESPONDENT
DR
Z
MAYET
FIFTH RESPONDENT
DR
DM MANYANE
SIXTH RESPONDENT
DR
TS BOGATSU
SEVENTH RESPONDENT
DISCLAIMER
This
judgment is issued by the Judge whose name is reflected herein and is
submitted electronically to the parties/ their legal
representatives
by email. The judgment is further uploaded to the electronic file of
this matter on Caselines by the judge or his
secretary. The date of
judgment is deemed to be 26 May 2023.
## JUDGMENT
JUDGMENT
Coram
NOKO AJ
Introduction
[1]
The applicant seeks the review and setting aside of the decision of
the first respondent which
determined that the injuries suffered by
the applicant did not qualify as serious injuries as contemplated in
terms of Road Accident
Fund Act 56 of 1986 (as amended) (
the Act
).
The application is being opposed only by the first and third
respondents.
Background
[2]
The applicant was involved in a motor vehicle accident on 15 January
2012 and suffered emotional
shock/ psychological injuries. The
applicant was driving a motor vehicle following another motor vehicle
driven by her brother-in-law
in which her sister and her two children
were passengers. The insured vehicle negligently collided with the
vehicle driven by the
brother-in-law and thereafter proceeded to
collide with the applicant’s motor vehicle. The applicant’s
brother-in-law
and one child were fatally injured and the applicant’s
sister and her sister’s other child sustained serious injuries.
The applicant did not suffer physical injuries but only psychological
injuries which were as a result of the applicant having witnessed
the
fatal accident where her brother-in-law and her nephew died. The
applicant lodged a claim for general damages in terms of the
Act with
the second respondent. The second respondent rejected the general
damages claim by the applicant.
[3]
It is common cause that the applicant was examined by several health
and medical practitioners
to assist in the determination of the
compensation for damages suffered pursuant to the motor vehicle
accident. The medical examinations
were at the instance of both the
applicant and the second respondent. Relevant to this dispute the
applicant was examined and or
assessed by Dr Theo Enslin, an
Independent Medical Examiner and Dr David A Shevel, a psychiatrist,
Dr Maaronganye, a psychiatrist,
Ms Kgomotso Montwedi, an Occupational
Therapist and Dr Amanda Peta, a Clinical Psychologist. Both Drs
Shovel and Enslin certified
that the applicant satisfied the
requirements for and is entitled to be compensated for general
damages.
[4]
The applicant was examined at the instance of the second respondent
by Dr MS Moloto, an Orthopaedic
surgeon and Dr Maaroganye who was a
psychiatrist. Dr Moloto certified that the applicant does not
qualify for non-pecuniary
or general damages as the orthopaedic
injuries did not satisfy the requirements in terms of the AMA Test.
Dr Moloto further reported
that an Occupational Therapist must be
engaged to assess whether the applicant qualifies for the general
damages in relation to
psychological injuries and its sequalae. The
applicant was further assessed by a psychiatrist Dr Kagisho
Maaroganye and in his
assessment concluded that the applicant
suffered from Post Traumatic Stress disorder (PTSD).
[5]
In view of
Dr Moloto having reported that the applicant does not qualify for the
general damages after examining the applicant as
orthopaedic surgeon
the second respondent rejected the claim for general damages. The
attorneys for the second respondent having
stated that “
[W]e
confirm our client’s instructions to reject your RAF 4 Form on
the basis of our Orthopaedic Surgeon report completed
by Dr MS Moloto
served on your office on the 9
th
October 2017”.
[1]
Legislative
scheme
[6]
Where the
second respondent is not satisfied that a claimant was not correctly
assessed for general damages the fund may refer the
claimant for
further assessment
[2]
alternatively reject the claim and give reasons. If the claim is
rejected the claimant may lodge appeal in terms of regulation
3(4) by
completing and lodging dispute resolution form (RAF 5) with the
registrar of the Health Professions Council of South African
within
90 days of the rejection. The Health Professions Council will
constitute an Appeal Tribunal which will determine the dispute.
[7]
In the determination of the dispute the Appeal Tribunal will follow
the procedure as set out in
regulations 3(4) to 3(13). The said
procedure includes, considering submitting the claimant to a further
assessment, or conducting
its own examination and or obtaining
further medical reports. The Appeal Tribunal may also hold a hearing
and receive legal arguments
from both sides and seek recommendation
from a legal practitioner in relation to legal issues raised and may
consider submissions,
opinions or medical reports from both parties.
[8]
In view of the rejection of the claim by the second respondent the
applicant lodged an appeal
with the third respondent. The third
respondent constituted an Appeal Tribunal which consisted of the
fourth to the seven respondents,
being three Orthopaedic Surgeons and
a Neurologist. The Appeal Tribunal decided that the applicant did not
qualify for compensation
for general damages.
[9]
The record of the decision and the reasons of the first respondent
was made available to the court
and was referred in
ad verbatim
in para 25 of the applicant’s founding affidavit. The decision
of the first respondent to dismiss the appeal was on the basis
that
the applicant’s injuries were not serious.
[10]
Being aggrieved by the decision of the Appeal Tribunal the applicant
launched this proceeding for an order reviewing
and setting aside of
the decision of the Appeal Tribunal, further that the court should
declare that the applicant’s psychological
injuries and the
sequelae satisfy the requirements for general damages and that the
applicant be compensated accordingly, alternatively
that the third
respondent be ordered to re-appoint an Appeal Tribunal to determine
the dispute pursuant to the rejection of the
applicant’s
general damages by the second respondent.
[11]
The applicant seeks to challenge the decisions on the following basis
that, first, that the first respondent considered
irrelevant facts to
arrive at its decision. Secondly, that the first respondent was
biased in favour of the second respondent.
Thirdly, that the decision
of the first respondent was taken without good reason, as
contemplated in terms of subsection 5(3) of
Promotion of
Administrative Justice Act (PAJA), as the first respondent failed to
furnish adequate reasons for its decision.
[12]
The first
respondent in retort contended that, first,
[T]he
psychological sequelae as suffered by the Applicant does not qualify
in terms of the Narrative Test as a serious injury.
Secondly
,
[T]he finding of the first respondent was not unreasonable or
irrational.
Thirdly
,
[T]he Applicant has failed in her duty to take reasonable steps in
order to minimise the damage suffered.
[3]
The respondents having stated that “
[I]t
is common cause that, as a result of the accident the applicant
suffered from emotional shock and trauma, including Post-Traumatic
Stress Disorder (hereinafter PTSD). What is in dispute is the
seriousness of the damages suffered”.
[4]
Issues
for determination.
[13]
The
application for condonation as the applicant has filed its answering
affidavit outside the prescribed time lines.
[5]
[14]
The court is called to determine whether the first respondent’s
decision is susceptible to review and should
be set aside.
Condonation
[15]
The respondents have delivered the opposing affidavit out of time and
have therefore applied for the condonation
for the late filing of the
answering affidavit. The applicant in reply stated that there is no
opposition to the application for
condonation and to this end this
court having noted that the condonation is exclusively within the
discretion of court and was
persuaded that no prejudice will visit
any party if condonation is granted for the late filing of the
opposing affidavit.
Arguments
and submissions by the parties.
[16]
Though the applicant did not delineate her arguments under specific
headings I have for clarity and coherence purposes
captured the
arguments under the headings set hereunder.
Irrelevant
considerations
[17]
The counsel for the applicants advanced the following contentions,
first, that the first respondent had regards
to the opinion of an
orthopaedic surgeon appointed by the second respondent who
specifically stated that the applicant does not
qualify for general
damages in relation to the applicant’s assessment of the
applicant’s orthopaedic injuries. This
was not relevant as the
injuries were psychological and not orthopaedic in nature.
[18]
Secondly,
that the first respondent could have had regard to clear indication
by Dr Moloto that for the purposes of psychological
injuries and
sequelae
the applicant should be examined by the correct medical expert and
suggested a clinical psychologist in this regard. In addition,
the
first respondent should have been guided by the reports which were
prepared by a psychiatrist, namely Dr Maaroganye, who was
appointed
by the second respondent and also Drs Enslin and Shevel
(psychiatrist) who were appointed by the applicant. All these
medical
practitioners confirmed that the applicant qualified in terms of the
narrative test and should be compensated for the general
damages.
[6]
[19]
Thirdly, that the first respondent further had regards to the
contents of the reports of both Clinical and Occupational
psychologists who were appointed at the instance of the second
respondent. Their reports are irrelevant, so the argument went,
when
compared with the reports which were compiled by the psychiatrists as
the latter were better qualified to provide a persuasive
opinion as
medical practitioners whereas clinical and occupational psychologists
were not medical practitioners.
[20]
The
respondent on the other hand, denied that irrelevant factors were
considered and stated that reference was made of the reports
of other
experts including the applicant’s own Occupational Therapist
“
who
reported that the applicant had stopped taking her anti-depressants
and anti-anxiety tablets as she felt it was affecting her
working
ability”.
[7]
In addition, psychological report from Ms K Montwedi reported that
the “
[T]he
identified cognitive fallouts are very mild and should not interfere
with her work abilities and her daily activities”
.
Dr Amanda Peta who reported that the applicant’s
psychological perspective is entirely favourable and she does not
seem to have suffered a major
sequelae
.
[8]
To this end, so contends the respondents’ counsel, even though
there is clear psychological damage as a result of the accident,
the
sequelae seem to be unclear except that the applicant failed to take
measures to minimise the damage.
[21]
I have noted that the respondents contended in the papers before this
court that all reports were considered but
annexure X10 states that
the reports of T Enslin, Shevel, Maaronganye, both T Enslin and
Shevel stated that the injuries were below
30% WPI. These reports
make no reference to qualification for general damages on the basis
of narrative tests and reference should
have been made of Drs Enslin
and Shevel whose reports whilst they confirmed that the applicant
does not qualify in terms of WPI
they concluded that the applicant
does qualify for general damages under the Narrative Test.
[22]
It is also
axiomatic that the rejection of the general damages by the second
respondent was based on irrelevant consideration being
the report of
Dr Moloto who made assessment in relation to orthopaedic injuries.
The said Dr Moloto having stated unequivocally
that assessment for
general damages in relation to psychological injuries is deferred to
a specialist in that discipline. The first
respondent should have
decided on this fact alone that the rejection of the general damages
by the second respondent was based
on wrong facts. Of utmost
importance for consideration should have been a report as per RAF 4
which is a prerequisite to assess
whether compensation for general
damages should be allowed or not.
[9]
This would have been noted from the reports from Drs Enslin and
Shevel. The refusal to have regards to such reports justifies the
conclusion that the appeal tribunal had regards to the irrelevant
considerations in coming to its conclusion.
[23]
The above
conclusion is further fortified by the conclusion reached by the
first respondent which was on the basis of the reports
by the experts
who did not complete the RAF 4 and were not qualified to prepare such
reports as they were not medical practitioners
or certified to make
assessments contemplated in terms of regulation 3. The Supreme Court
of Appeal held in
Duma
v RAF
2013 (6) SA 9
SCA at para [33] that a person not registered as a
medical practitioner may not complete a valid RAF 4 serious injury
report.
[10]
The deference of
Dr Moloto on behalf of the second respondent that Clinical
psychologist should assess the applicant to determine
eligibility for
non-pecuniary damages would have been of no consequence as the
psychologist is not a medical practitioner. There
were also no
impediments which barred the first respondent and/or even the second
respondent to have the applicant being assessed
by further medical
practitioner/s.
[24]
The arguments in the opposing affidavit, including the reference to
other reports which were not set out in the
first respondent’s
decision appears to have been afterthought and intended to embellish
reasons stated in the report are
irrelevant for the purposes of this
lis
. The facts set out in the affidavits are ordinarily not
intended to relook into the decision taken by the Appeal Tribunal and
attempts
to modify and or add on those reason should be frowned at
from whence they lurk.
Acting
contrary to the enabling legislation.
[25]
The applicant advanced two contentions in this regard, first, that
regulation 3(8)(b) specifically provides that
the Appeal Tribunal
shall consist of the three independent medical practitioners with
expertise in the appropriate areas of medicine.
As such failure by
the third respondent and to proceed with the panel adjudicating
despite a plea by the applicant that the panel
was not properly
constituted (and should at least have a psychiatrist as a member) was
unreasonable and offended the very regulation
prescribing the
composition of the Appeal Tribunal. The panel members did not have
expertise in the appropriate areas of medicine,
being psychiatry. The
failure to react to the objection raised by the applicant with regard
to the composition of the panel denied
the applicant an opportunity
in terms of regulation 3(9) to object to the composition of the
panel.
[26]
Secondly, the members of the panel were supposed to be three and in
this instance the panel was constituted by
four members. This is
inconsistent with regulation 3(8)(b) as members should be three
medical practitioners and a health practitioner.
[27]
The
respondent contended in retort that the fact that the tribunal has
exceeded the number of required experts does not
ipso
facto
constitutes an irregularity and instead it would work in favour of
the applicant. This contention was informed by the decision
in
L
Roux v Road Accident Fund Appeal Tribunal
2016 JDR 0648 (GP)
[11]
where
it was held that such will rather benefit an appellant. Le Roux
judgment also referred to
Brown
v Health Professions Council of South Africa
Case no 6449/2015 (Western Cape Division) Bozalek J where he stated
at para 46 that “
it
does not follow from regulation 3(8)(b) that, should the report of a
particular medical specialist or practitioner such as an
occupational
therapist serve in front of them, the panel is incomplete or
improperly constituted unless it too comprises an occupational
therapist
”.
[28]
The
respondent contended further that second issue raised by the
applicant that it is an irregularity for the first respondent for
not
ensuring that at least a psychiatrist is appointed on the panel is
unsustainable. In this regard, so went the argument, the
applicant
failed to show the required qualifications which ought to apply to
members of the panel.
[12]
Regulation 3(8)(b) refers to independent medical practitioners
with
expertise in the appropriate areas of medicine
being appointed by the registrar. The members of the panel were all
medical practitioners as defined by the Health Professions
Act 56 of
1974. Section 1 of the Act defines “
medical
practitioner as a person registered as such under this Act
”.
The respondent further submitted that the applicant appears to have
confused the expertise as required in terms of
regulation 3(8)(b)
with being a specialist
[13]
.
The panel members were specialists though not a requirement it would
be improper to state that they do not hold suitable expertise.
[14]
The specialist in medical sphere referring to “…
a
doctor who works in and knows a lot about one particular area of
medicine”
.
[15]
[29]
In support
of its argument above the respondent’s counsel made reference
to Dr Enslin who is not a specialist but satisfied
the requirements
as envisaged in regulation (2008) 3(1)(b) after completing a
specified training course to make assessment of injuries
for general
damages claim. He needed not to be a psychiatrist and or even an
orthopaedic surgeon. In the end since the regulation
makes no
reference that a psychiatrist should have been appointed on the panel
the applicant should discharge the onus to persuade
the court of the
authority or the reading in the regulation that at least one of the
panel members should have been a psychiatrist.
And further that the
“…
orthopaedic
and neurologist did not have expertise in the appropriate areas of
medicine
”.
[16]
[30]
The issue
which this court need to consider is to determine what is the
appropriate
area of medicine
.
I have noted an aggressive and vociferous attempt by the respondent
that the panellist members need not be specialists but fails
to
explain what appropriate areas of medicine would be. It follows from
the respondents’ contention that it would be correct
to have a
gynaecologist being on a panel to assess injuries relating to the
nervous system or a psychiatrist being on a panel to
assess
orthopaedic injuries. The respondent indirectly admitted the weakness
of the analogy in this example as it is stated in
para 47.2
[17]
indeed there was on panel a medical practitioner who is proficient in
the type of the injuries the applicant purported to have
suffered.
The essence is an acknowledgment that the type of injury should
provide a cue as to the kind of a medical practitioner
is proficient
in a specific area of medicine to be on the panel.
[31]
I note that the meaning of the word appropriate means suitable or
relevant. If the usage of the word appropriate
was not important then
the legislator would have stated that any medical practitioner should
be appointed on the Appeal Tribunal
for any type of injuries. This
appears to be absurd and in support hereof it was held in
Mokhemisa
CP obo M v Health Professions Council of South Africa and Others
(33540/2017) [2019] Gauteng Division (31 May 2017), per Snyman AJ
that it was intended to mean that “
the expertise must be
ascertained having regard to the injuries sustained by the claimant”
.
One should find it difficult to fathom the reason underpinning the
contention that a general practitioner is as good as a medical
practitioner who has expertise in any relevant field of medicine.
[32]
It follows that the contention by the applicant that the panel was
not properly constituted is meritorious and
the impugned decision of
the first respondent is susceptible to be reviewed and should also be
set aside.
Unfair
process
[33]
The applicant contended that it is not apparent from the report and
or reasoning by the first respondent for not
having invoked the
provisions of the regulations and refer the applicant for another
assessment if the RAF 4 report by Dr Enslin
was insufficient. Noting
further that second respondent did not put into dispute the integrity
of that report.
[34]
The first
respondent advanced as its reason for not referring the applicant for
further examination as being the fact that unnecessary
costs would be
incurred in instances where the decision of the second respondent was
correct from the beginning.
[18]
[35]
In retort, the first respondent contended that the provision that the
appeal can obtain further medical reports
is not peremptory and can
be done instances where it is imperative. The respondent made
reference to
JH v Health Professions Council of South Africa
2016 (2) 93 (WCC) where it was held that the Tribunal Appeal is
possessed with discretion and not obligated to always obtain further
medical reports.
[36]
The appeal tribunal is further enjoined in terms of regulation 3(11)
to examine the applicant alternatively refer
the applicant for a
further assessment to determine if the applicant qualifies for the
general damages.
[37]
The fact that the applicant requests to include another expert
(psychiatrist) was not considered thereby denying
her the opportunity
to present arguments before being dismissed rendered the decision
taken unfair. The refusal by the third respondent
to provide the
applicant with reply that her request was dismissed was unfair and
also denied the applicant the opportunity to
formally challenge the
composition of the panel on the Appeal Tribunal.
Biasness
[38]
The applicant contended that the first respondent appears to have
rejected the reports submitted at the instance
of the applicant and
failed to provide reasons why such reports were discarded and further
why they were not considered in contrast
to other reports. The
affidavit from the first respondent confirms that the reports from
the two experts, namely, Kgomotso Montwedi,
an Occupational Therapist
and Dr Amanda Peta, a Clinical Psychologist, commissioned at the
instance of the second respondent whose
reports suggest to the first
respondent that the applicant did not suffer serious injuries to
warrant compensation for general
damages.
[39]
The applicant contended further that there are two averments in the
affidavit of the respondent from which it became
apparent that the
first respondent was biased. First, in paragraph 14.2 of the opposing
affidavit the first respondent sided with
the second respondent as it
is stated that “
[I]t needs to be pointed out that at the
stage of rejection all current medico-legal reports were in
possession of the Road Accident
Fund, and same had been duly
considered prior to a decision having been reached”
.
The applicant contends that there was no basis for the respondent to
make such a statement under oath having regard
to the fact that the
second respondent was very specific that the rejection of the claims
for general damages was based on the
medico-legal report prepared by
Dr Moloto and not on any other report or reports. In addition, the
statement by the respondent
in this regard was not supported by
confirmatory affidavit from the second respondent. Secondly, the
first respondent further stated
that there was no need to refer the
applicant for further assessment or examination as the rejection of
the claim for general damages
was correct from the beginning. The
evidence clearly indicate that the rejection was based on the report
of Dr Moloto who unequivocally
stated that he is not qualified to
proffer a proper assessment of psychological injuries. There was
therefore no basis for the
first respondent to state that the
rejection was correct from the beginning and bar any exculpatory
explanation the inference of
bias is inevitable.
[40]
The absence
of bias is catalyst for a fair process which earns credence in the
eyes of the public. The administrator is therefore
enjoined to always
be impartial. Devenish having stated that “
[T]he
partiality or appearance of partiality of even one member of an
administrative tribunal suffices to vitiate the whole
proceedings”.
[19]
I note that there is merit in the complaint by the applicant and
worse the first respondent makes no indication as to whether the
said
statements were based on information which served before the appeal
tribunal or is confirmed by affidavit or otherwise by
the second
respondent. Absent any explanation leaves me with an ineluctable
conclusion that the respondent was not impartial and
was biased in
favour of the second respondent and to this end the impugned decision
is found wanting, reviewable and bound to be
set aside.
Failure
to provide adequate reasons
[41]
Section 5(3) of PAJA provides that in instances where an
administrative action is not backed by adequate reason
provided then
it must be presumed that such an administrative decision was taken
without a good reason. The applicant having contended
that since the
first respondent denied the contents of both X5 and X10 the
respondent should have then provided the basis upon
which the
decision was taken. On a proper reading of paragraphs 20 and 42 of
the respondent’s opposing affidavit though not
in the perfect
draftmanship the first respondent does not deny the report annexed to
the pleadings marked X10 but only deny the
contents of the paragraphs
of the applicant’s founding affidavit and not the contents of
their report as suggested by the
applicant. To this end the
contention by the applicant is unsustainable.
Conclusion
[42]
Having regard to reason explained above I find that the decision by
the first respondent that the applicant did
not qualify for general
damages is incongruent to facts which served before the Appeal
Tribunal and the grounds for the review
justify the conclusion that
the decision is reviewable. In the result the application must
succeed.
Costs
[43]
There is no basis to deviate from the general principle that the
costs should follow the results.
[44] In
consequence, I make the following order:
1. The
decision of the first respondent dated 1 August 2018 that the
applicant did not suffer serious injuries
as contemplated in
secion17(1A) of the Road Accident Fund Act, (as amended) as read with
Regulations issued thereunder, is reviewed
and set aside.
2. The
third respondent is directed to re-appoint a new Appeal Tribunal,
constituted in terms of regulation 3(8)
consisting of only 3 medical
practitioners with expertise in the appropriate fields of medicine
and if necessary, an additional
health practitioner with expertise in
any appropriate health profession to assist in an advisory capacity.
3. The
new Appeal Tribunal is ordered to allow the applicant and the second
respondent to be represented at the
hearing and to provide further
submissions and or any evidence as the applicant and second
respondent may wish to present.
4. The
first and third respondent are ordered to pay the costs of the
application jointly and severally the one
paying the other to be
absolved.
NOKO
MV,
ACTING
JUDGE OF THE HIGH COURT
GAUTENG
DIVISION, PRETORIA
APPEARANCES
Applicant’s
Counsel:
Adv MJ Fourie,
Circle Chambers
Applicant’s
Attorneys:
Erasmus de Klerk
Attorney
1
st
and
3
rd
Respondents’ Counsel:
Adv M Hugo
1
st
and
3
rd
Respondents’ Attorneys:
Dyson Incorporated
Date of hearing:
16 February 2023.
Date of judgment:
26 May 2023.
[1]
Annexure X3 to the Applicant’s Founding Affidavit.
[2]
See
Regulation 3(1)(b).
[3]
See
Respondents’ Heads of Arguments Caselines A4-2, at para 1,2.
[4]
Respondents’
Heads of Argument Caselines A4-2 at para 2.2.
[5]
See
the parties joint practice note under Caselines A2- 3 at para 9.
[6]
The
conclusion by these Drs were supported by other applicant’s
Drs, namely, Dr HB Enslin (Orthopedic surgeon), Ms Crosby
(Occupational therapist) Mr Anthony Townsend, (a clinical
psychologist).
[7]
Para
3.4 on Caseline A4-4
[8]
Para
3.7 on Caselines A4-6
[9]
The
importance of RAF 4 was also conceded by the first respondent who
asserted in respect of the applicant’s contention
that the
second respondent’s Dr Maaroganye also stated that the
applicant qualifies for general damages and stated on Caseline
A5-6
in para 36.3 of the first and third Respondent’s Opposing
Affidavit where it is stated that “
[I]t
needs to be remembered, that in order to be compensated for
non-pecuniary damages, an administrative step has to be concluded,
being the completion of a RAF 4 assessment in which an expert
indicates whether the applicant would be entitled to either
compensation
in terms of the AMA Guides on a WIP basis alternatively
via the Narrative Tests”
.
Further at para 66.4, that “
[I]n
relation to this specific expert, none of these aspects and
procedures have been followed and as such it is submitted that
the
contentions made in this paragraph are without any basis and
consequently denied by the respondents
”.
[10]
See
a contrary view in
Mngomezulu,
Zamokwakhe Comfort v Road Accident Fund
(04643/2010[2011] ZAGP JHC (8 September 2011) quoted with approval
in unreported judgment of
Chairikira
v The Road Accident Fund Tribunal and Others
(72371/2014) [2021] Gauteng Division (8 February 2021), Fourie J
[11]
See
First and Second Respondents heads, para 32-31, CaseLines A4-30
[12]
See
para 5.4 of the respondent heads CaseLines A4-21
[13]
The
word specialist may be defined as a person who concentrates on a
particular subject or activity; a person highly skilled in
a
specific and restricted field. Para 28 A4-29. And medical specialist
means a “
medical
practitioner who has been registered as a specialist in a speciality
or related specialities and a subspecialiaty (if
any) in medicine in
terms of these Regulations”.
A4-25 para 16.
[14]
Respondent’s
Heads
of Arguments at para 26 on Caselines A4-27.
[15]
Respondents’
Heads
of Arguments at para 29 on Caseline A4-29.
[16]
Para
8 on Caselines A4-23.
[17]
See respondents’ opposing affidavit on
Caseline
5-622. At the same time contending that the Dr Moloto, an orthopedic
surgeon who was appointed by the second respondent
should have
assessed the applicant as he was a general practitioner before
becoming a specialist and had “…
the
competency to comment on the state of the applicant’s mental
wellbeing”.
[18]
See
para 48.9 of the First Respondent Opposing Affidavit on Caselines
A5-625.
[19]
Devenish
GE, Govender K and Hulme D, “
Administrative
Law and Justice in South Africa
”,
2001, Butterworts, at 338.
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